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General NPI Number Information
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NPI Number | 1619217650
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Entity Type | Individual
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Provider Name | FANITA SANDERS HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 100 N VILLAGE AVE SUITE 17
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3767
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Country | US
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Telephone | 516-330-0870
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Fax | 516-330-0870
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Provider Business Mailing Address
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Address Line | 793 E CARL AVE
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1902
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Country | US
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Telephone | 516-330-0870
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Fax | 516-705-5050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004277
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License Number State | NY
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